EP2142132B1 - System zur nicht mechanischen beschränkung und/oder programmierung der bewegung eines werkzeugs eines manipulators entlang einer einzelachse - Google Patents

System zur nicht mechanischen beschränkung und/oder programmierung der bewegung eines werkzeugs eines manipulators entlang einer einzelachse Download PDF

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Publication number
EP2142132B1
EP2142132B1 EP08832194A EP08832194A EP2142132B1 EP 2142132 B1 EP2142132 B1 EP 2142132B1 EP 08832194 A EP08832194 A EP 08832194A EP 08832194 A EP08832194 A EP 08832194A EP 2142132 B1 EP2142132 B1 EP 2142132B1
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EP
European Patent Office
Prior art keywords
tool
computer system
input device
move
axis
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Not-in-force
Application number
EP08832194A
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English (en)
French (fr)
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EP2142132A2 (de
EP2142132A4 (de
Inventor
Alexander Greer
Garnette Sutherland
Tim Fielding
Perry Newhook
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Neuroarm Surgical Ltd
Original Assignee
Neuroarm Surgical Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Neuroarm Surgical Ltd filed Critical Neuroarm Surgical Ltd
Priority claimed from PCT/IB2008/003351 external-priority patent/WO2009044287A2/en
Priority claimed from PCT/IB2008/003323 external-priority patent/WO2009037576A2/en
Publication of EP2142132A2 publication Critical patent/EP2142132A2/de
Publication of EP2142132A4 publication Critical patent/EP2142132A4/de
Application granted granted Critical
Publication of EP2142132B1 publication Critical patent/EP2142132B1/de
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
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    • B—PERFORMING OPERATIONS; TRANSPORTING
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    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J3/00—Manipulators of master-slave type, i.e. both controlling unit and controlled unit perform corresponding spatial movements
    • B25J3/04—Manipulators of master-slave type, i.e. both controlling unit and controlled unit perform corresponding spatial movements involving servo mechanisms
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
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    • B25J9/1664—Programme controls characterised by programming, planning systems for manipulators characterised by motion, path, trajectory planning
    • B25J9/1666—Avoiding collision or forbidden zones
    • B—PERFORMING OPERATIONS; TRANSPORTING
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    • B25J9/16—Programme controls
    • B25J9/1656—Programme controls characterised by programming, planning systems for manipulators
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    • G05B—CONTROL OR REGULATING SYSTEMS IN GENERAL; FUNCTIONAL ELEMENTS OF SUCH SYSTEMS; MONITORING OR TESTING ARRANGEMENTS FOR SUCH SYSTEMS OR ELEMENTS
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    • G05B2219/36—Nc in input of data, input key till input tape
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    • G—PHYSICS
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    • G—PHYSICS
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    • G05B2219/40—Robotics, robotics mapping to robotics vision
    • G05B2219/40418—Presurgical planning, on screen indicate regions to be operated on
    • G—PHYSICS
    • G05—CONTROLLING; REGULATING
    • G05B—CONTROL OR REGULATING SYSTEMS IN GENERAL; FUNCTIONAL ELEMENTS OF SUCH SYSTEMS; MONITORING OR TESTING ARRANGEMENTS FOR SUCH SYSTEMS OR ELEMENTS
    • G05B2219/00—Program-control systems
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    • G05B2219/45—Nc applications
    • G05B2219/45117—Medical, radio surgery manipulator
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
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    • G16H30/00—ICT specially adapted for the handling or processing of medical images
    • G16H30/40—ICT specially adapted for the handling or processing of medical images for processing medical images, e.g. editing

Definitions

  • the present methods, devices, and systems relate generally to the field of surgical robotics, and more particularly to the non-mechanical restriction of a manipulator (e.g., a robotic arm with multiple degrees of freedom) to movement of a tool by the manipulator along a single axis.
  • a manipulator e.g., a robotic arm with multiple degrees of freedom
  • An example of a procedure that can be carried out according to the present methods, devices, and systems is an automated biopsy.
  • An example of a surgical robot that can be used in a procedure to which the present methods, devices, and systems relate is disclosed in U.S. Patent No. 7,155,316 (the "'316 patent").
  • the pre-planned path is derived from an image taken hours before the procedure.
  • the brain is not fixed within the cranial cavity and can shift as a result of damage, tumours, hydration, and body position changes. These relatively small brain shifts can be problematic in term of accuracy and pose a safety concern.
  • post surgical images and other tools are used to ensure accurate and safe procedures with existing tools.
  • attachment of a head frame to the patient's head is also required; this is both uncomfortable and time consuming.
  • the present invention relates to a computer system configured to perform at least the following functions:
  • Another aspect of the present invention relates to a computer readable medium having stored thereon machine readable instructions for performing at least the functions of any one of claims 1 to 13.
  • Embodiments of the present methods and systems enable a user, such as a surgeon, to set up and execute an automated move of a tool of one of the robotic arms (which includes a tool that is coupled to the robotic arm, as well as a tool that is integrated with the robotic arm) along a single axis, such as the longitudinal axis of the tool.
  • a move may be particularly advantageous when implemented as an automated biopsy of tissue, such as brain or breast tissue.
  • the automated move may be programmed to occur during a stereotactic procedure, when some or all of the robotic arm is positioned within the bore of an open or closed magnet of a magnetic resonance imaging machine, or during a microsurgical procedure during which one or both robotic arms may be set up to and execute such an automated move.
  • Robots that may be manipulated according to the present techniques may be characterized as computer-assisted devices.
  • the present systems take the form of a computer system useful in simulating, planning and/or executing an automated surgical procedure.
  • the computer system is configured to perform at least the following functions: receive data designating a target location for a tool held by a medical robot; receive data designating a second location for the tool from which the tool will move toward the target location during an automated movement; and move the medical robot in response to a user command to begin the automated movement such that the tool moves along a single axis defined by the second location and the target location.
  • the data designating the target location may comprise coordinates (e.g., Cartesian coordinates) of the tip of the tool, or coordinates of a location spaced away from the tool along a longitudinal axis of the tool, in any suitable coordinate system, or data sufficient to enable determination of such coordinates (such as joint values of the robotic arm that allow forward kinematics to be used to solve for the coordinates based on known parameters such as robotic arm link lengths).
  • coordinates e.g., Cartesian coordinates
  • coordinates of a location spaced away from the tool along a longitudinal axis of the tool in any suitable coordinate system, or data sufficient to enable determination of such coordinates (such as joint values of the robotic arm that allow forward kinematics to be used to solve for the coordinates based on known parameters such as robotic arm link lengths).
  • the present devices take the form of a computer readable medium comprising machine readable instructions for receiving a command to restrict movement of an instrument held by or integral with a robotic arm along a single axis, the robotic arm being configured for use in surgery; receiving a position and orientation of an input device, the input device being linked to the robotic arm through a master-slave relationship in which the input device is the master, the difference between the position and orientation of the input device and a previous position and orientation of the input device corresponding to a desired movement of the instrument; and sending a signal or signals to effect a move of the instrument in accordance with the desired movement, where the move will be along the single axis and will not include any movement along any different axis from the single axis.
  • the signal or signals may be any suitable form of data that includes information sufficient to cause the robotic arm to move appropriately.
  • the signal or signals could represent a set of joint displacements and/or joint velocities outputted to a local controller for the robotic arm or directly to the individual joint actuators.
  • the user may set up a procedure by delivering inputs to a computer system through an input device, such as a hand controller that is linked as a master to the robotic arm in a master-slave relationship.
  • an input device such as a hand controller that is linked as a master to the robotic arm in a master-slave relationship.
  • the user may also deliver inputs through one or more graphical user interfaces (GUIs) using any suitable input device, such as touch screen controls (e.g., buttons, slider bars, drop down menus, tabs, etc.), a mouse, or the like.
  • GUIs graphical user interfaces
  • Some embodiments of the present systems are computer systems that may be configured to display on a display screen a GUI that allows the user to select a simulation mode (e.g., through a control such as a button that can be selected via a touch, a mouse, or the like) for setting up the automated movement and otherwise for training.
  • the computer system also may be configured to display on the GUI one or more controls (e.g., that can be selected via a touch, a mouse, or the like) for selecting the type of surgery, such as microsurgery, stereotaxy with one of the robotic arms, or stereotaxy with the other robotic arm.
  • the computer system also may be configured to display on the GUI one or more controls (e.g., that can be selected via a touch, a mouse, or the like) for activating power to: the robotic arms (e.g., through separate buttons); a base motor for adjusting the height of the base on which the robotic arms sit during microsurgical procedures; a digitizing arm usable during the physical registration process for registering a structure (e.g., of a radiofrequency coil assembly) associate in a fixed relationship with a portion of a subject to one or both robotic arms; a field camera usable during microsurgery to capture images of the surgical field; and a bore camera or cameras to be positioned in the bore of a magnet of a magnetic resonance imaging machine.
  • the robotic arms e.g., through separate buttons
  • a base motor for adjusting the height of the base on which the robotic arms sit during microsurgical procedures
  • a digitizing arm usable during the physical registration process for registering a structure (e.g., of a radiofrequency coil assembly) associate in
  • the computer system also may be configured to display on the GUI one or more controls (e.g., that can be selected via a touch, a mouse, or the like) for activating a single axis lock (e.g., a Z-axis lock) and another button or buttons for controlling which robotic arm to associate the single axis lock with.
  • a single axis lock e.g., a Z-axis lock
  • another button or buttons for controlling which robotic arm to associate the single axis lock with.
  • the computer system also may be configured to display on one or more additional display screens one or more additional GUIs for displaying two-dimensional images (one at a time) of a portion of a subject and for displaying a three-dimensional representation (e.g., a set of 2D images that form a 3D dataset of images representing a volume) of a portion of a subject.
  • a three-dimensional representation e.g., a set of 2D images that form a 3D dataset of images representing a volume
  • the computer system may be configured to display one or more controls (e.g., buttons, tabs, or the like that can be selected via a touch, a mouse, or the like) that a user can select to display either 2D images (one at a time) or a 3D image.
  • the computer system also may be configured to display a zoom button, slider bar, or the like (e.g., that can be selected/manipulated via a touch, a mouse, or the like) that will allow a user that has selected the 2D display to zoom in on a given 2D image, where the 2D image remains centered as it is enlarged or reduced in size.
  • a zoom button e.g., that can be selected/manipulated via a touch, a mouse, or the like
  • the computer system also may be configured to display controls (e.g., that can be selected via a touch, a mouse, or the like) that allow a user to turn on a tracking feature for one of the two robotic arms that will be displayed as crosshairs representative of the location of either (a) the working tip (e.g., the distal tip) of a tool of the robotic arm selected or (b) the end of a line that extends from the tool tip, and further may be configured to display controls (e.g., buttons, slider bars, or the like that can be selected via a touch, a mouse, or the like) that allow a user to activate the display of the extension line and control the length of the extension line.
  • controls e.g., that can be selected via a touch, a mouse, or the like
  • a given 2D image may comprise an oblique slice that is oriented perpendicular to the tool axis. Such slices interpolate pixels between the 2D slices to achieve off-axis images.
  • the 3D image also changes in response by 2D slices that make up the 3D image being taken away or added depending on the depth of the tool/extension line into the subject.
  • the computer system may also be configured to display, when either the 2D or 3D display is selected, a section corresponding to planning for an automated biopsy that includes a display of controls (e.g., that can be selected via a touch, a mouse, or the like) that can be used to set a target location (associated with a location of the crosshairs at the time when the target location button is selected) for an automated movement along a single axis (e.g., an automated biopsy); a second point (characterizable as a start point, though a given movement may not begin exactly at the start point; the second point being associated with a location of the crosshairs at the time when the second button is selected) that together with the target location defines a path for the tool movement; a tool alignment function, that can be used when a user desires to position the relevant robotic arm in place (e.g., within a preset distance, ranging from zero to some relatively small distance (e.g., 2 centimeters)) for the automated move procedure, and that when pressed will
  • the computer system may also be configured to display an indicator (e.g., a colored circle) for the target location selected by the user; a line extending from the indicator and to the tool tip or extension line tip (whichever is used) following selection of the target location, the line being designed to show the user the path through the subject if the line is followed, the computer system being configured to alter the appearance of the line when a second point is selected (e.g., changing the line's color or shape).
  • an indicator e.g., a colored circle
  • the computer system may be configured to perform at least the following functions: receive a command (e.g., through a user's touch of the screen displaying the relevant GUI) identifying a target location for a tool used in an automated movement by a robotic arm; receive a command identifying a starting location for the tool; receive a command to execute an automated move along a path (e.g., a line) defined at least in part by the starting location and the target location; and execute the automated move such that the tool, which may have a longitudinal axis, travels along the path (e.g., along a single axis). That path also may be aligned with the tools longitudinal axis.
  • a command e.g., through a user's touch of the screen displaying the relevant GUI
  • receive a command identifying a starting location for the tool
  • receive a command to execute an automated move along a path e.g., a line
  • a path e.g., a line
  • That path also may be align
  • the computer system may also be configured to receive (e.g., prior to the command identifying the target location) a command selecting which robotic arm to use for the automated move. In some embodiments, the computer system may also be configured to receive (e.g., prior to the command identifying the target location) a command indicating a simulation and/or setup mode that disengages an input device that is linked in a master-slave relationship to a robotic arm holding or integrated with the tool, such that in the simulation mode movement of the input device does not cause movement of the robotic arm.
  • the computer system may also be configured to receive a command (e.g., prior to the command identifying the target location) indicating a user's activation of the input device (such as through the user touching a button on in the input device with the user's hand), which activation allows the user to alter the position of the tracking indicator showing the location of the would-be tool tip relative to the image(s) of the subject as the user determines where to position the tracking indicator for selection of the target and starting locations.
  • the computer system may also be configured to receive a command (e.g., after the command identifying the starting location) indicating a new (e.g., a second) target location.
  • the computer system may also be configured to receive a command (e.g., after the command identifying the starting location) indicating a new (e.g., a second) starting location. In some embodiments, the computer system may also be configured to receive a command (e.g., after the command identifying the starting location) indicating termination of the simulation and/or setup mode. In some embodiments, the computer system may be configured to display on a GUI a control (e.g., that can be selected via a touch, a mouse, or the like) that can be used to select a mode in which the input device is engaged with the robotic arm in a master-slave relationship.
  • a control e.g., that can be selected via a touch, a mouse, or the like
  • the computer system may be configured to receive a command, when in the master-slave mode, enabling the input device (e.g., by holding the input device and pushing a button on the input device with a finger of the user).
  • the computer system may be configured to receive a command to execute the automated move along a path that is defined at least in part by the starting and target locations, the computer system also be configured to cause the robotic arm in a way that moves the tool in a single axis along the path only after it has received a command indicating the input device is enabled (e.g., such that a user must be holding the input device in order for the automated move to proceed).
  • the computer system may be configured to stop the robotic arm from completing the automated move if it receives a command to stop the automated move (e.g., through a user pushing the same button on the input device that otherwise enables the input device), and may also be configured to display on a GUI a message that includes buttons or the like (e.g., that can be selected via a touch, a mouse, or the like) for continuing with the automated move, reversing direction, or stopping, and may be configured to receive a command to either continue, reverse direction or stop, depending on the button or the like that is activated, provided it first receives a command indicating the input device is enabled (e.g., by holding the input device and pushing a button on the input device with the user's finger).
  • a command to stop the automated move e.g., through a user pushing the same button on the input device that otherwise enables the input device
  • buttons or the like e.g., that can be selected via a touch, a mouse, or the like
  • any embodiment of any of the present methods, devices, and systems may consist of or consist essentially of-rather than comprise/include/contain/have-the described steps and/or features.
  • the term “consisting of' or “consisting essentially of” may be substituted for any of the open-ended linking verbs recited above, in order to change the scope of a given claim from what it would otherwise be using the open-ended linking verb.
  • an element of a method, device, or system that "comprises,” “has,” “contains,” or “includes” one or more recited features possesses those features, but is not limited to possessing only those features; it may possess features that are not recited.
  • a computer readable medium “comprising" (or “encoded with") machine readable instructions for performing certain steps is a computer readable medium that has machine readable instructions for implementing at least the recited steps, but also covers media having machine readable instructions for implementing additional, unrecited steps.
  • a computer system that is configured to perform at least certain functions is not limited to performing only the recited functions, and may be configured in a way or ways that are not specified provided the system is configured to perform the recited functions.
  • the invention is a software enabled single-axis lock for movement of a tool along the single axis by a robotic arm with multiple degrees of freedom.
  • the software solution allows a robotic arm with an unlimited number of degrees of freedom to behave in the same fashion as a robot or device that is mechanically restricted to motion of its tool along the single axis.
  • a command may be sent to the software to lock the motion by a given robotic arm of its tool (meaning a tool the robotic arm is holding or that is integral with the robotic arm; the present tools may be characterized more specifically as medical tools or surgical tools) in a single axis using any suitable input device, such as a button on a touch screen on a GUI, a button on an input device (e.g., a hand controller), or the like.
  • the apparatus to which the inventive techniques may be applied may, in some embodiments, include a slave robotic arm commanded by a master input device, such as a hand controller.
  • a master input device such as a hand controller.
  • FIG. 1A An example of a pair of input devices (in the form of hand controllers) that can be used to control two different robotic arms, respectively, of a medical or surgical robotic system are shown in FIG. 1A .
  • Input devices 20, which are mirror images of each other, each includes a stylus 25 that can be held like a long pen, lever 27 that can be squeezed toward stylus 25 to cause a tool integrated with or held by the slave robotic arm to actuate (e.g., squeezing lever 27 can cause forceps to close), and an enable/disable button 29 that can be touched and held for a short amount of time in order to activate the input device.
  • One way to hold input devices 20 is to grasp stylus 25 so that lever 27 can be squeezed with the forefinger and so that button 29 can be touched with the thumb.
  • FIG. 1B shows an enlarged view of the left-handed input device 20.
  • One manner of creating a non-mechanical single-axis tool movement lock involves the following:
  • the rate of execution of the above loop may be arbitrarily small to produce linear motion at the tool tip.
  • the movement of a tool along a single axis may be pre-programmed so as to be automated.
  • FIGS. 1C-3C detailed views of a manipulator 100 and a surgical tool 150 are shown in various positions as the manipulator 100 causes movement of the tool along a single axis in a stereotactic procedure (such a movement also may be achieved in any other procedure, such as a microsurgical procedure).
  • Manipulator 100 which is an example of a multi-degree of freedom robotic arm (specifically, manipulator 100 may be characterized as a six degree of freedom slave manipulator, and it is similar in functionality and operation to the robotic arms disclosed in the '316 patent), assembly 200 comprising a head clamp and radiofrequency coil device (which is coupled to the head clamp, and which can be further coupled to the operating room table by a fixable multi link arm), and cameras 190 (only one of which is visible (the other is on the opposite side of the extension board)) are coupled to an extension board 260.
  • Extension board 260 may be coupled to any suitable table or other structure having a patient support surface (not shown). In the views shown, a schematic drawing of a patient's head 300 is shown held by the head clamp of assembly 200.
  • FIGS. 1C and 1D show manipulator 100 in a first position in which surgical tool 150 is located outside of head 300, near opening 350 in head 300, which may be a burr hole or any other suitable surgical opening. However, tip 160 of surgical tool 150 is outside of opening 350.
  • FIG. 1E is a side view of the position shown in FIGS. 1C and 1D , and does not include assembly 200 for clarity.
  • FIGS. 2A and 2B show manipulator 100 moved to a second position in which tip 160 of surgical tool 150 has been advanced along axis 110, and no other axis, by manipulator 100 so that tip 160 has penetrated the boundary of opening 350.
  • FIG. 2C is a side view of the position shown in FIGS. 2A and 2B , and does not include assembly 200 for clarity.
  • FIGS. 3A and 3B show manipulator 100 moved to a third position in which tip 160 has moved along axis 110 into a location within head 300, which it can be further manipulated by a user/operator (e.g., a surgeon) to perform any of a number of functions, such as taking a biopsy of tissue.
  • FIG. 3C is a side view of the position shown in FIGS. 3A and 3B , and does not include assembly 200 for clarity.
  • Axis 110 is substantially aligned (perfectly aligned in the depicted embodiment) with the longitudinal axis (not separately shown) of tool 150. For other tools that have bends or angles, the tool and tool tip will still move along a single axis, however that axis may not coincide with a longitudinal axis of the tool itself.
  • FIG. 4 illustrates a perspective view of a workstation 400 that can be used to control manipulator 100 (or two such manipulators) and surgical tool 150 (or two such surgical tools, one held by each of two such manipulators).
  • workstation 400 comprises input devices 20 shown in FIGS. 1A and 1B to control movement of manipulator 100.
  • Workstation 400 may include a table to which the input devices are secured as well as a series of display screens, including display screens 401 and 402, each of which can provide a graphical user interface (GUI) that can be used in setting up a procedure using manipulator 100.
  • GUI graphical user interface
  • the GUI shown on display screen 401 may be used to select two points that will define the axis (or path or trajectory) along which the tip of the relevant tool travels in an automated single axis movement (such a screen is referred to as a command status display (CSD) in this document) and the GUI shown on display screen 402 may be used to display one or more images from a three-dimensional dataset of images of a subject taken using a three-dimensional imaging device, such as a magnetic resonance imaging device, which may be viewed as a determination is made by an operator about which points to select on display screen 402 (such a screen is referred to in this document as a magnetic resonance image display (MRID)).
  • the other display screens depicted in FIG. 4 may be used to show other images or displays associated with a given procedure involving one or both manipulators 100.
  • FIGS. 5-11 illustrate various screen displays that can be used as GUIs for displays 401 and 402.
  • multiple controls such as buttons, slider bars, radio buttons, check boxes, drop down menus, and the like
  • buttons, slider bars, radio buttons, check boxes, drop down menus, and the like are provided on each screen for receiving user input through any suitable means, such as through touching the screen, manipulating an input device such as a mouse, or the like. Only those controls relevant to the features presented in this disclosure will be discussed.
  • a computer system may be configured such that starting the primary application supported by the computer system brings the user to a startup screen as illustrated in FIG. 5 .
  • Those of ordinary skill in the art having the benefit of this disclosure will be able to write code (machine readable instructions, which can be implemented through software, hardware, firmware, or a combination of any two or more of these) without undue experimentation for accomplishing the features (including the graphical user interfaces) described below and shown in the figures.
  • FIG. 5 illustrates a CSD 401 that can be used in setting up a desired mode for one or both manipulators (such as a "Z Axis Lock” representative of a manipulators ability to move its tool along only one axis) or a desired procedure, such as an automated move (e.g., along a single axis) of a surgical tool by a given manipulator 100.
  • manipulators such as a "Z Axis Lock” representative of a manipulators ability to move its tool along only one axis
  • a desired procedure such as an automated move (e.g., along a single axis) of a surgical tool by a given manipulator 100.
  • This display includes options for selecting procedure types (microsurgery, stereotaxy left arm, stereotaxy right arm), as well as power selections for the right arm, left arm, a base motor for adjusting the height of the arms (manipulators 100) supported on a mobile and lockable base, a field camera for capturing images during microsurgery and a digitizing arm for use in the physical part of subject image-to-manipulator registration.
  • the power buttons are shown in the "Mode Controls" tab, as is the "Surgery Type.”
  • Manipulators 100 are shown in an unhighlighted manner on the GUI shown in FIG. 5 , signifying that neither has been selected for using in either training/simulation or a procedure using the buttons at the bottom left of the screen.
  • a suitable technique for registering one or more two-dimensional images of a portion of a subject with one or both manipulators 100 is disclosed in co-pending International Application No. PCT/US08/60538 .
  • suitable registration may include both an MRI registration aspect to locate the imaged subject to a physical structure and a physical registration aspect to register a given manipulator to that physical structure, set up may begin.
  • a user may select a simulation mode by selecting the "Training Simulation Mode” button under the "User Settings” tab shown in CSD 401 of FIG. 6 . Selecting the simulation mode can allow the user to view simulated movements of manipulator 100 and surgical tool 150 in response to movements of the input device, without causing actual movement of manipulator 100.
  • the word “simulation” also appears near the bottom portion of the display, as shown for example in FIGS. 5-7 .
  • simulation mode a user can view a potential path of travel of surgical tool 150 that may be used in a surgical procedure. This allows a user to evaluate multiple potential paths of manipulator 100 and surgical tool 150 before defining one as described below for actual use in the procedure.
  • CSD 401 in FIG. 7 illustrates the system in simulated stereotaxy mode with the left arm enabled.
  • This version of CSD 401 now shows only one manipulator as a result of the left arm selection, and shows it in a highlighted state. It also shows an upper portion of an RF coil device (from assembly 200) positioned over a graphical representation of a subject's head (e.g., head 300). It also shows that the user has enabled power to the left arm and a "Bore Camera” (or cameras, such as camera 190 shown in FIGS. 1C-3C , which may be exposed without being affected to the magnetic field created in an MRI environment) and the digitizing arm (note that the unselected "Right Arm” and "Base Motor” buttons are unselected and grayed out).
  • a "Bore Camera” or cameras, such as camera 190 shown in FIGS. 1C-3C , which may be exposed without being affected to the magnetic field created in an MRI environment
  • the digitizing arm note that the unselected "Right Arm”
  • FIG. 8 illustrates a version of CSD 401 indicating that a user has selected to place the right arm in stereotaxy mode and Z Axis Lock mode, where the tool that has been selected for use by the right manipulator is shown on the right lower part of the screen (and is the same biopsy tool shown in FIGS. 1C-3C ).
  • the mode of the displayed manipulator shown in FIG. 8 was achieved through a user's selection of stereotaxy right arm (as shown in the buttons in FIG. 5 ), master/slave mode via selection of the Master/Slave button shown in FIG. 8 , and the enablement of the right arm by selecting "Right Arm” in the "Arm Enable” box of the "Mode Controls” tab shown in FIG. 8 .
  • the user enables the input device associated with the right manipulator by depressing button 29 on right hand controller 20.
  • the user can manipulate the enabled input device to put the manipulator into the position and orientation desired by the user for movement of the tool along a single axis.
  • the user can disable control of the manipulator by again pushing button 29; otherwise, the user can proceed to enabling the z-axis lock for the tool held by that manipulator by (in the depicted embodiment) selecting "Right Tool” in the "Z Axis Lock” box of the "Mode Controls” tab shown in FIG. 8 .
  • the tool held by the manipulator will only travel along the axis defined (in the depicted embodiment) by the upper portion of the tool where it is held by the tool holder portions coupled to the end effector of the manipulator (which, in this embodiment, is a longitudinal axis that is centered in the entire length of tool), such travel occurring in the forward or backward directions depending on the user's motion of the input device.
  • the user can push the same "Right Tool” button to disable that mode.
  • FIG. 9 illustrates a version of CSD 401 indicating that a user has selected microsurgical mode and simulation mode, and enabled both manipulators (which are both highlighted) and selected tools for them.
  • a user may enable the Z Axis Lock function for the tools of both arms from this version of CSD 401.
  • the selected tool for each manipulator is shown to the side of the manipulator (bipolar forceps on the left and biopsy tool on the right).
  • FIG. 10 illustrates a version of CSD 401 in which a simulated stereotaxy left arm mode has been selected (by, for example, selecting the "Stereotaxy Left Arm” button shown in FIG. 5 ), the left arm has been enabled, the Z Axis Lock function has been selected for the left tool.
  • MRID 402 depicts a GUI that allows a user to toggle between 2D and 3D views taken with a 3-D imaging modality (such as an MRI machine) of a portion (such as the head) of a subject, as reflected in the 2D tabs "2D Tools” and “2D View” at the bottom left of the screen and in the 3D tabs "3D Tools” and “3D View” at the bottom right of the screen.
  • a 3-D imaging modality such as an MRI machine
  • an indicator in this example, crosshairs
  • the tip e.g., tip 160
  • the relevant tool e.g., surgical tool 150, or, in other embodiments, the terminal end of an extension line that extends from the tool tip a distance selected using the slider bar shown underneath the "Tool Tip Extension:" box beneath the tool that is being tracked
  • the slider bar shown underneath the "Tool Tip Extension:” box beneath the tool that is being tracked
  • the 2D Tools tab has been selected, and a two-dimensional image is shown overlaid by the crosshairs indicator showing the location of the tip of the right tool within the subject.
  • crosshairs appear in response to a user selecting the "Track" button beneath the section for the relevant tool(s).
  • the Track option on MRID 402 a user can view the MRID as he or she manipulates the relevant input device to follow (or track) the location of the tool tip (or tool tip extension line end point, and regardless of whether the user is in simulation/training mode) relative to the subject, as it travels through the subject.
  • the 3D Tools tab has been selected and the location of the tip of the tool relative to the subject's head is shown in 3D, where the 3D image is shown in this embodiment cut away on a plane that is normal to the axis along which the tool tip will travel, as a result of the selection of the "Plane Cut” button within the "Right Tool” box near the right of the screen.
  • a user can manipulate the orientation of the 3D image through any suitable input device (e.g., a space ball) to move the displayed image and the overlaid tool so as to provide a desired view of the tissue affected by the proposed tool position and path.
  • This overlay feature becomes available following the physical and MRI registration process and receipt of tool selection.
  • Selection of the "Simple” button will replace the tool image with, for example, a thin red line of the same length as the tool so as not to obstruct the view of small structures.
  • Selection of the "Wedge Cut” button will cut into the displayed 3D image at the location of the tool tip/extension line end by cutting away a wedge to reveal three orthogonal planes (e.g., sagital, axial, coronal), where the tip of the tool/extension line end is at the juncture of the three planes.
  • a user may first select a mode on the CSD, such as Stereotaxy Left Arm Mode, and then enable the left arm and power on the bore camera(s). The user may then choose the Simulation Mode on the CSD to disengage the left manipulator (which may, for example, be a left version of manipulator 100 from FIGS. 1C-3C or one of the manipulators shown in the '316 patent) from the motion of the relevant input device (such as input device 20).
  • a mode on the CSD such as Stereotaxy Left Arm Mode
  • the user may then choose the Simulation Mode on the CSD to disengage the left manipulator (which may, for example, be a left version of manipulator 100 from FIGS. 1C-3C or one of the manipulators shown in the '316 patent) from the motion of the relevant input device (such as input device 20).
  • the user may then select the 2D Tools tab and the Track mode/function in the "Left Tool” box, causing the crosshairs to appear overlaying the relevant 2D image of the subject when the 2D mode is selected.
  • a user may select a non-zero "Tool Tip Extension” value, using the slider bar, if a tool tip extension line is desired. If the Tool Tip Extension function is set greater than 0.0 mm, the crosshairs will track the location of the end of the extension line. If this parameter is set at zero, the tracking function will illustrate crosshairs on the 2D slice image at the location of the tip (distal end) of the tool.
  • subsequent 2D images e.g., 2D slices
  • prior 2D slices are shown.
  • the user can grasp the left input device and enable virtual or simulated motion of the tool by actuating (e.g., via use of the thumb) an enable button (e.g., button 29) on the input device.
  • the user can then take the input device, and based on visual cues gained from toggling, as desired, between the 2D and 3D MRID views, move the virtual manipulator shown on the CSD and the manipulator's surgical tool to the area of the intended target.
  • the CSD and the 2D and 3D MRID images can update in real time to show the location of the virtual (when in simulation mode) manipulator and its tool.
  • the user may disable the input device so that movement of the input device does not lead to further movement of the virtual manipulator and its tool.
  • a user can then push "Target” to select the target location for the procedure, which is stored in terms of X, Y and Z Cartesian coordinates of the tool tip in image space (e.g., magnetic resonance imaging space), which is then transformed to robot space.
  • image space e.g., magnetic resonance imaging space
  • a target location indicator will appear at the crosshairs location (for example, a red circle) in the 2D view and at the tool tip or extension line end location in the 3D view denoting the intended target.
  • a user can then enable the input device if it has been disabled (and in the same way that the input device was disabled) and cause the tool tip or extension line end to move toward the intended insertion point for the subject.
  • a path indicator (for example, a green line) can then be visible in the 3D view that links the tip/extension line end to the selected target so that the user can see the trajectory and any tissue that will be penetrated or disturbed by the proposed tool tip path.
  • the user may then move the input device to the desired entry point (which could be, for example, at the surface of the brain or head, or a small distance outside the head). If a burr hole has already been made, a user may ensure that the path goes through the burr hole without contacting the head. The user may then, but need not, disable the input device when the entry point and trajectory are acceptable.
  • a user may then push the button labeled "Start Point" on either the 2D or 3D version of the MRID and an indicator (e.g., a green circle) will appear at the crosshairs location in the 2D view and at the tool tip or extension line end location in the 3D view denoting the intended start point, which is stored in terms of X, Y and Z Cartesian coordinates of the tool tip in image space (e.g., magnetic resonance imaging space), which is then transformed to robot space. These coordinates are registered as the tool tip if the extension line value equals zero, or as the end of the extension line if that value is greater than zero.
  • an indicator e.g., a green circle
  • the indicator will change in some way (e.g., the green line will turn red) to denote that the line (or path) is set, and the start point, termination point and trajectory (or path) will appear on the CSD.
  • the user can use the input device to move the simulated tool tip/extension line to a new location and push the "Start Point" or "Target” button again in either the 2D or 3D version of the MRID.
  • the system will ask the user to push the relevant button a second time to confirm replacement of the old point with a new point. After an acceptable trajectory is chosen, the user can exit the simulation mode on the CSD by designating that button again (e.g., by touching it on the screen again).
  • a user can execute the automated move by choosing the master/slave mode on the CSD, enabling the input device (e.g., by depressing button 29), and moving the input device to cause the manipulator (while watching the MRID and/or the bore camera or field camera image shown on display screen 403 shown in FIG. 4 ) to move to a location close to the start point selected for the movement and to be in an orientation that is as close to the selected trajectory as possible.
  • the user may then disable the input device.
  • the user can push the "Tool Align” button (see, e.g., FIGS. 11 and 12 ) and the manipulator will move to align with the programmed trajectory and place the tool tip at or near the selected start point (such as approximately two centimeters radially outward from the start point along the programmed trajectory).
  • the user may then push the "Execute” button (under “Automated Biopsy"), and the user may be prompted to enable the input device to begin the automated movement (e.g., an automated biopsy).
  • the user may then grasp the input device and enable the system to begin the automated biopsy by enabling the input device in the same way it has been previously enabled (e.g., by pushing button 29). Taking this step causes the user to hold the input device in order for the procedure to take place.
  • the tool may move forward at a predetermined rate (which can be set in an initialization file) to the target location, at which point the surgical tool can perform a pre-programmed function, such as removing biopsy material.
  • the surgical tool is a biopsy tool equipped with two small sharpened scoops that open away from each other about axes that are normal to the longitudinal axis of the tool
  • the surgical tool's scoops will open, rotate 90 degrees clockwise, and close again, capturing tissue as a result.
  • the surgical tool can then reverse direction straight out along the insertion trajectory.
  • the user can disable the input device (e.g., by depressing button 29) to stop the move.
  • the CSD will then present the user with a selection box, such as the one shown in FIG. 13 , that includes options to stop, continue, and reverse direction. Once a selection is chosen, the tool will move again when the user enables the input device.
  • embodiments of the present methods, devices, and systems may therefore also allow a user (e.g., a surgeon) to simulate multiple paths for a surgical tool prior to conducting the actual surgical procedure, evaluate those paths for the tissue they may affect, and choose a desired path by selecting a target point and a start point.
  • the present devices and systems are configured to limit (electronically) the tool to a linear path; as a result, only a start point and a target point are needed to determine the tool path.
  • Embodiments of the present devices and system may also comprise multiple safety features to allow the user to maintain control of the tool.
  • Embodiments of the present methods may be coded as software stored on any suitable computer readable media (e.g., tangible computer readable media), such as any suitable form of memory or data storage device, including but not limited to hard drive media, optical media, RAM, SRAM, DRAM, SDRAM, ROM, EPROM, EEPROM, tape media, cartridge media, flash memory, memory stick, and/or the like.
  • Tangible computer readable media includes any physical medium that can store or transfer information. Such embodiments may be characterized as tangible computer readable media having (or encoded with) computer executable (e.g., machine readable) instructions for performing certain step(s).
  • tangible computer readable medium does not include wireless transmission media, such as carrier waves.
  • the term "computer readable medium,” however, does cover wireless transmission media, and some embodiments of the present methods may include wireless transmission media carrying the computer readable instructions described above.
  • the software can be written according to any technique known in the art. For instance, the software may be written in any one or more computer languages (e.g., ASSEMBLY, PASCAL, FORTRAN, BASIC, C, C++, C#, JAVA, Perl, Python) or using scientific packages like, but not limited to, Matlab®, R, S-plus®, and SAS®.
  • the code may be to enable it to be compiled on all common platforms (e.g., Microsoft®, Linux®, Apple Macintosh® OS X, Unix®).
  • the software may include a GUI, which may provide a user with a more intuitive feel when running the software.
  • Different fields may be accessible by screen touching, a mouse and/or keyboard.
  • Alarms, cues, and the like may be done via pop-up windows, audible alerts, or any other techniques known in the art.
  • Some (up to all) of the steps described in the sections above may be implemented using a computer having a processor (e.g., one or more integrated circuits) programmed with firmware and/or running software.
  • Some (up to all) of the steps described in the sections above may be implemented using a distributed computing environment, which is one example of a computer system.
  • multiple computers may be used, such as those connected by any suitable number of connection mediums (e.g., a local area network (LAN), a wide area network (WAN), or other computer networks, including but not limited to Ethernets, enterprise-wide computer networks, intranets and the Internet, and the connections between computers can be wired or wireless).
  • Servers and user terminals can be part of a given computer system.
  • embodiments of suitable computer systems may be implemented on application specific integrated circuits (ASICs) or very large scale integrated (VLSI) circuits, and further (or alternatively) may be configured to use virtualization of resources, virtual computing, and/or cloud computing to achieve the specified functions.
  • ASICs application specific integrated circuits
  • VLSI very large scale integrated circuits
  • persons of ordinary skill in the art may utilize any number of suitable structures capable of executing logical operations in order to achieve the functions described above in a computer system consistent with this disclosure.

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Claims (14)

  1. Computersystem, das konfiguriert ist, um wenigstens folgende Funktionen durchzuführen:
    Empfangen eines Befehls, die Bewegung eines Tools (150), das operativ mit einem Roboterarm verbunden ist, entlang einer einzelnen Achse (110) einzuschränken, wobei der Roboterarm (100) für die Verwendung in der Chirurgie konfiguriert ist;
    Empfangen eines ersten Datensatzes, der eine erste Position und erste Ausrichtung eines Eingabegeräts (20) definiert, wobei das Eingabegerät über ein Master-Slave-Verhältnis umkehrbar mit dem Roboterarm (100) gekoppelt ist, wobei das Eingabegerät (20) der Master ist;
    Empfangen eines zweiten Datensatzes, der eine zweite Position und zweite Ausrichtung des Eingabegeräts (20) definiert;
    Bestimmen einer Komponente der Differenz zwischen der ersten Position und ersten Ausrichtung des Eingabegeräts (20) und der zweiten Position und zweiten Ausrichtung des Eingabegeräts (20) entlang einer Achse, wobei die eine Achse durch eine Transformation der einzelnen Achse (110) zugehörig ist; und
    Senden eines oder mehrerer Signal(e), um eine Bewegung des Tools (150) auszulösen, wobei die Bewegung durch die Komponente und die Transformation ausgelöst wird, wodurch die Bewegung auf entlang der einzelnen Achse (110) beschränkt ist.
  2. Computersystem nach Anspruch 1, das ferner konfiguriert ist, um wenigstens Folgendes durchzuführen:
    Empfangen von Daten, die ausreichend sind, um eine Position eines Abschnitts des Tools (150) und eine Ausrichtung des Tools (150) zu bestimmen, wobei das Tool eine Längsachse aufweist, wobei die einzelne Achse (110) in Verbindung mit der Längsachse des Tools (150) definiert ist; und
    Empfangen eines Bewegungsbefehls, um das Tool (150) zu bewegen;
    wobei das eine oder die mehreren Signal(e) zum Auslösen der Bewegung des Tools als Reaktion auf den Bewegungsbefehl gesendet wird/werden.
  3. Computersystem nach Anspruch 1 oder 2, wobei das Computersystem bei der Simulation, Planung und/oder Durchführung eines automatisierten chirurgischen Eingriffs nützlich ist und wobei das Computersystem ferner konfiguriert ist, um wenigstens folgende Funktionen durchzuführen:
    Empfangen von Daten, die basierend auf dem ersten Datensatz eine Zielposition für das Tool (150) angeben;
    Empfangen von Daten, die basierend auf dem zweiten Datensatz eine zweite Position für das Tool (150) angeben; und
    Empfangen eines Automatisierungsbefehls, um eine automatisierte Bewegung des Tools (150) zu beginnen, wobei das eine oder die mehreren Signal(e) als Reaktion auf den Automatisierungsbefehl gesendet wird/werden und die ausgelöste Bewegung die automatisierte Bewegung des Tools (150) ist und wobei die einzelne Achse (110), entlang derer sich das Tool (150) bewegt, durch die zweite Position und die Zielposition definiert ist.
  4. Computersystem nach Anspruch 3, das ferner konfiguriert ist, um Kopplungsdaten zu empfangen, die anzeigen, dass das Eingabegerät (20) mit dem Roboterarm (100) gekoppelt oder nicht gekoppelt ist, und wobei die Bewegung nur dann stattfindet, wenn die empfangenen Kopplungsdaten anzeigen, dass das Eingabegerät (20) mit dem Roboterarm (100) gekoppelt ist.
  5. Computersystem nach einem der Ansprüche 1, 2, 3 oder 4, das ferner konfiguriert ist, um wenigstens die folgende Funktion durchzuführen:
    Auslösen einer Manipulation des Tools (150) an der Zielposition.
  6. Computersystem nach Anspruch 3 oder 4, das ferner konfiguriert ist, um wenigstens folgende zusätzliche Funktionen durchzuführen:
    Anzeigen einer simulierten Darstellung des Tools (150);
    Anzeigen einer dreidimensionalen Darstellung eines Abschnitts eines Patienten;
    vor dem Empfangen der Daten, die die zweite Position angeben, Anzeigen einer Verlaufsplanungslinie, die von der Zielposition zu einer Spitze der simulierten Darstellung des Tools verläuft, überlagert auf der dreidimensionalen Darstellung des Abschnitts des Patienten; und
    Bewegen der Verlaufsplanungslinie als Reaktion auf eine Eingabe von einem Eingabegerät, das mit der simulierten Darstellung des Tools verknüpft ist.
  7. Computersystem nach einem der Ansprüche 3, 4 oder 6, wobei das eine oder die mehreren Signal(e), das/die als Reaktion auf den Automatisierungsbefehl gesendet wird/werden, die automatisierte Bewegung in einer vorbestimmten Geschwindigkeit, die sich von einer Echtzeitreaktion auf die Manipulation des Eingabegeräts (20) unterscheidet, auslöst/auslösen; und wobei das Computersystem ferner konfiguriert ist, um einen Befehl zum Beenden der automatisierten Bewegung zu empfangen, bevor die automatisierte Bewegung abgeschlossen ist.
  8. Computersystem nach Anspruch 6, das ferner konfiguriert ist, um wenigstens die folgende Funktion durchzuführen:
    Anzeigen, zusätzlich zu der simulierten Darstellung des Tools (150), eines Anzeigers, der einen Pfad von der zweiten Position zu der Zielposition abbildet.
  9. Computersystem nach Anspruch 3 oder 4, das ferner konfiguriert ist, um wenigstens folgende Funktionen durchzuführen:
    Anzeigen einer simulierten Darstellung des Roboterarms;
    Anzeigen einer simulierten Darstellung des Tools (150);
    Empfangen eines Befehls zum Arbeiten in einem Simulationsmodus, wobei das Eingabegerät im Simulationsmodus umkehrbar mit der simulierten Darstellung des Roboterarms verknüpft sein kann;
    Anzeigen einer ersten zweidimensionalen (2D) Abbildung eines Abschnitts eines Patienten;
    Anzeigen eines Anzeigers der Zielposition überlagert auf der 2D-Abbildung;
    Bewegen des Anzeigers als Reaktion auf eine Eingabe;
    Anzeigen einer dreidimensionalen (3D) Darstellung eines Abschnitts des Patienten mit der simulierten Darstellung des Tools überlagert auf der 3D-Darstellung, sodass eine Spitze des Tools oder eine vom Tool aus fortgesetzte Linie in derselben relativen Position angezeigt wird, wie der Anzeiger der Zielposition;
    Bewegen der Spitze des Tools oder der Linie als Reaktion auf eine Eingabe; und
    Verändern der 3D-Darstellung als Reaktion auf die Eingabe.
  10. Computersystem nach Anspruch 9, das ferner konfiguriert ist, um eine zweite 2D-Abbildung eines Abschnitts des Patienten anzuzeigen.
  11. Computersystem nach einem der Ansprüche 1 bis 10, wobei das Bestimmen der Komponente der Differenz entlang der einen Achse das Bestimmen eines Deltawerts zwischen dem ersten Datensatz und dem zweiten Datensatz in der einen Achse umfasst, und
    wobei das Computersystem ferner konfiguriert ist, um folgende Funktion durchzuführen:
    Bestimmen eines entsprechenden Deltawerts für das Tool in der einzelnen Achse basierend auf dem Deltawert in der einen Achse.
  12. Computersystem nach Anspruch 11, wobei das Bestimmen des entsprechenden Deltawerts das Nullsetzen aller vom Eingabegerät (20) empfangenen Parameter der nicht einzelnen Achse umfasst.
  13. Computersystem nach Anspruch 11, wobei das Bestimmen des entsprechenden Deltawerts das Bestimmen der Deltawerte in mehr als einer Achse und das Auswählen des entsprechenden Deltawerts in der einzelnen Achse (110) aus diesen Deltawerten umfasst.
  14. Computerlesbares Medium, auf dem maschinenlesbare Anweisungen zum Durchführen wenigstens der Funktionen nach den Ansprüchen 1 bis 13 gespeichert sind.
EP08832194A 2007-04-16 2008-04-16 System zur nicht mechanischen beschränkung und/oder programmierung der bewegung eines werkzeugs eines manipulators entlang einer einzelachse Not-in-force EP2142132B1 (de)

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PCT/IB2008/003351 WO2009044287A2 (en) 2007-04-16 2008-04-16 Methods, devices, and systems for automated movements involving medical robots
PCT/IB2008/003323 WO2009037576A2 (en) 2007-04-16 2008-04-16 Methods, devices, and systems for non-mechanically restricting and/or programming movement of a tool of a manipulator along a single axis

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US8560118B2 (en) 2013-10-15
EP2142132A2 (de) 2010-01-13
US20140114480A1 (en) 2014-04-24
IL201559A0 (en) 2010-05-31
EP2142132A4 (de) 2011-03-02
US20100198402A1 (en) 2010-08-05
US9131986B2 (en) 2015-09-15

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